Albania: Rising Expectations Drive Growing Health Care Needs

IAEA, Partners Focus Support on Slowing the Spread of Cancer

21 April 2008

Once locked in decades of isolation, Albania is seeing new horizons in the fight against poverty. Expectations run high, driving demands for better — and healthier — lives.

“People are raising their expectations,” says Dr. Alban Ylli of the Institute of Public Health and Hygiene. “They want better, more accessible health services. The Ministry of Health is trying to keep pace with those expectations, but there are problems.”

One growing problem is cancer care and treatment. More than 4000 new cases are diagnosed every year, and cancer wards and waiting rooms are full. The IAEA, World Health Organization (WHO) and other partners are working to help Albania.

Growing Cancer Cases

At the Mother Teresa University Hospital in Tirana, Dr. Agim Sallaku is a very busy man. Head of the Oncology Institute, he is witnessing at first hand the surge in the country's cancer rates and in people's rising expectations for better care and treatment.

The Institute is the only cancer treatment centre serving the country's 3.6 million people. Its wards are filled with patients there for surgery, chemotherapy or radiotherapy. And every day, hundreds of day-patients crowd its narrow corridors, waiting for treatment or to speak to doctors.

In 1990, Albania recorded around 2800 new cancer cases a year. Today the Balkan country is seeing a 50% increase in cases and cancer is now second only to cardiovascular disease as a cause of death.

“Cancer is a multi-factorial disease and the way we live plays a big role,” says Dr. Sallaku. “Changes in lifestyle in Albania over the last 17 years — connected to food, smoking, pollution, physical activity, stress and so on — mean significantly increased risk factors.”

Changing Conditions

Since emerging from decades of isolation at the beginning of the 1990s, Albania has struggled with multiple challenges: political instability, economic disruption, and structural underdevelopment. It's still one of Europe's poorest nations, with an annual per capita income of less than $3000, but today there are many signs of progress and expansion, particularly in Tirana.

The city offers an astonishing parade of contrasts as modernity jostles with tradition: steel and glass office blocks standing next to squat shanties; sleek SUVs negotiating pot-holed highways; funky, minimalist cafes outside of which old men with ancient bathroom scales offer passers-by the chance to weigh themselves for just a couple of coins.

IAEA Support

The IAEA is working with Dr. Sallaku and his staff to tackle the growing cancer crisis on a broad front. In 2006, the Agency's Programme of Action for Cancer Therapy (PACT), together with WHO-EURO and IARC, conducted an interagency imPACT review. Its recommendations to the Albanian Ministry of Health form the basis of the national cancer strategy and action plan.

Also in 2006, the country was selected as a PACT Model Demonstration Site (PMDS), a development which is significantly advancing efforts to improve cancer control and attract new resources. Already, an additional radiotherapy machine from MDS Nordion was delivered to the Mother Teresa Hospital through PACT in coordination with the Agency's Department of Technical Cooperation (TC). The cost of this machine was shared by the Albanian government.

At the same time, TC is providing expertise and equipment, and facilitating regional training in fields such as radiation oncology. “Because of the specialized nature of radiation medicine, we are working closely with the government to ensure the Oncology Institute receives full support and that its personnel are competent. Safety is our priority,” says Mikiko Sawanishi, the Technical Cooperation Programme Management Officer for Albania. “PACT's modality is broader, focusing on all aspects of cancer care and control. I think the two approaches complement each other.”

As in many low-income countries, more than 70% of all cancer cases in Albania are diagnosed too late for effective treatment. Using current statistics, that's some 3000 terminal cancer patients a year. But because palliative care services are extremely limited, such patients and their families frequently lack any form of specialized end-of-life care or support.

To effectively reduce cancer incidence in Albania, health experts stress the urgent need to focus on raising awareness, prevention and early diagnosis. And to provide the palliation services that patients with untreatable cancers deserve.

“In my opinion these are the main challenges we're facing right now and which we must quickly move towards addressing,” says Dr. Sallaku. “The international organizations can help us a lot in this context. With their support and expertise, and our own energy and determination, we can help people and prevent suffering.”